Time matters in multiple sclerosis (MS). Irreversible neural damage and cell loss occur from disease onset when the frequency of inflammatory attacks on the central nervous system is often greatest. Finite neurological reserves and plasticity compensate and maintain normal functioning in early disease. When reserves are exhausted, symptoms typically worsen in a progressive fashion and become irreversible.
Manifestations include physical and cognitive decline, fatigue, reduced quality of life, compromised productivity and impaired functioning.